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Right Side Mandible and Masseter Pain?
Filed Under (Dental) by admin on 16-03-2010
Tagged Under : Appointment, Cerec, Cold Glass, Fluctuation, Molars
First, let me say this is NOT TMJ pain.
Here’s the deal:
Over several appointments from January to August of this year, I’ve had all of my upper and lower teeth from my canines through molars on the right side of my mouth restored with Cerec and BruxZir crowns and inlays. Long-term undiagnosed bruxism led to a lot of damage on that side of my mouth.
I had my last exam in November and everything checked out. I had some trouble with margins on two of the Cerecs in June and they were both swapped out for BruxZirs by another dentist who believed I would accelerate wear on them. He took over my care after the first dentist left to have a baby.
Around two to three weeks after that last appointment, I’ve had crazy pain in both my right masseter and mandible. I feel pain on pressure and any fluctuation in hot or cold. A cold glass of water is nearly intolerable on that side of my mouth. Is it possible for a patient to have a reaction to the cement under the crowns? These crowns weren’t anywhere near as sore when they were installed. I’m not sure what to do about it since two dentists have said my teeth and crowns look fine.
You’ve got apical periodontitis on the tooth that u experience pain on pressure. It needs to be evaluated using an IOPA (Intra Oral Peri Apical) radiograph. Sensitivity to cold water reconfirms the associated reversible pulpitis with the tooth.
Pain in the masseter muscle is usually indicative of a trigger point from hard clenching or grinding. Pain in the tooth or teeth may be due to sensitivity to the cement used but many dentists now seal the dentin (bare tooth) before cementing to prevent sensitivity.
Trigger points in the masseter muscle can refer pain to the upper and lower posterior teeth simulating toothache pain. These trigger points can be treated using physiotherapy. Bruxism/clenching can cause trigger points in muscles due to myospasm. Moist heat can bring relief from trigger points if you think this is the cause of your problems. Apply over the whole side of the face to cover the entire muscle for at least 45 – 60 minutes. Remember to include the angle of the mandible as fibers of the masseter emanate from that area.
Rather than have all that extensive work done to your natural teeth, it would have been much more conservative to make you an appliance to prevent further wear and tear to your teeth. An appliance called a NTi would have suffice unless the damage to your existing dentition was really severe.
I am really wary of any non metal restoration used to protect teeth from the ravages of bruxism because all advertising hype should be taken with a grain of salt until a long enough history has been established. Too many dental companies come out with ads that promise the world without a track record to fall back on, like BruxZirs. Cast gold would have been a better choice because it has an excellent history. If you had to make a choice between esthetics and longevity and durability, I would choose the latter two.
To address the problem you have, I think you will eventually end up with an appliance anyway.
yes it’s possible for irritation of pulpal tissue from a crown preparation that has approximated the pulp. dentist probably would have let you know though if the prep was close. but most of the time, he/she would have done something before cementing a crown on.
with a history of bruxism, my first impression would be the crowns are supra-occluded, or high, and your ‘bite’ has changed with the new crowns. porcelain is a hard material and can cause generalized tenderness as you described if you grind and their high. if the dentists said the crowns look ‘fine’ then they probably checked the bite with some contact paper and did alittle bit of coronal reduction. if they didn’t, try that first. may relieve some pressure off of those teeth.
could be a pulpal problem as the other people suggested. which would require a root canal, but again, if the dentists said the crowns look ‘fine’ they probably checked that too. if not, have them look to see if it’ll require a root canal.
if they and you are still dumbfounded then try an occlusal nightguard. it’s a thin piece of plastic that fits on either the upper or lower teeth. kinda of like a mouth guard football players wear, but not nearly as large. you’ll wear it at night.
good luck and take care.